A previously healthy 4-year-old boy was taken to the day care center by his parents, who reported intake of 30 ferrous sulfate tablets one hour prior to consultation.
The milligrams taken are not known.
The patient was admitted in a regular general state, with poor peripheral perfusion and depressed sensorium. The patient showed enophtalmic, generalized mucocutaneous, tachycardic and tachypical manifestations.
He has epigastric pain and blunt abdomen, depressible.
She was hospitalized and received supplementary oxygen, expansion with saline followed by parenteral hydration and intravenous ranitidine.
Rescue measures were taken.
Gastric lavage revealed a large number of coated tablets with reddish coloration followed by nasogastric tube drainage.
You have bloody vomiting
Abdominal radiograph of the foot was requested, which showed rounded radiopaque images, one in a gastric chamber and another in intestine, and a disseminated image for the left, compatible with dissolved tablets.
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The admission laboratory showed hyperglycemia, hypokalemia, increased transaminase and metabolic acidosis with increased remaining anion.
Ferremia was requested.
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Ev: The patient remains in regular general condition, persists with sensory deterioration, mucocutaneous irritation and presents three pork vomiting.
The result of the ferremia was 353 μg/dl (normal value: 90-180 μg/dl).
Considering the general state, internal environment alterations, elevated ferremia and images showing iron salts in the gastrointestinal intensive care unit, it was decided to administer iron in cardiovascular monitoring.
Treatment was initiated with deferoxamine at 30 mg/kg, followed by continuous intravenous infusion in 2 h.
Given the persistence of metabolic acidosis, correction with peripheral sodium bicarbonate is performed.
The patient remains 48 h in the PICU with good tolerance and response to treatment.
It normalizes laboratory parameters with decreasing ferremies after chelating treatment.
On the third day, an abdominal X-ray was requested, with no evidence of radiopaque images.
The patient had a good clinical evolution and was discharged on day 4.
There were no complications in the long-term follow-up.
